Megan Fobar

Dietetic Intern

Case Study Abstract: Nutrition Support in Neurocritical Care

A 15 year old patient, assessed at 60 inches and 471 pounds upon admit, presented to the
UCSD Medical Center after suffering a left-sided middle cerebral artery (MCA) stroke with
hemorrhagic conversion. A hemicraniectomy was immediately performed and the patient was
admitted to the Critical Care Unit. Nutrition support for this patient was complex due to his age,
body habitus, and critical condition. The approach to estimating and meeting the nutrition needs
of a 15 year old neuro critical care patient must account for a number of factors, including
ventilator dependence, intracranial pressure, propofol administration, increased sodium goals,
and the use of pressors. Since research related to the use of predictive equations in this
population is limited, the metabolic monitor was used to verify the estimated needs. Post-pyloric
tube feeds have been used to provide nutrition support, with frequent adjustments to the formula
and infusion rate based upon current needs and other factors. Additional events that have
affected nutrition support for this patient include hyperphosphatemia, periods of increased stool
output, a high-risk PEG placement, and a gastrointestinal bleed. This patients status has
gradually improved over his two-month hospitalization and he was recently transferred out of the
intensive care unit. Nutrition support continues to be an important factor for strengthening his
rehabilitation potential as he begins to work more intensively with physical, occupational, and
speech therapy.

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